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OSCE Notes in Otology cases

Station 1:
Look at the patient's face.
Examine his right external auditory canal

1. Name the syndrome

Ramsay Hunt syndrome
2. Name the causative organism
Varizella zoster virus
3. Name the other areas where rashes can be seen in this syndrome
Anterior 2/3 of tongue, soft palate, external auditory canal, and pinna

Station 2:
Name the various eye care procedures which should be followed in treating the patient at
the previous station
1. Wearing of eye glasses to prevent corneal damage
2. Instilling moisturizing eye drops to prevent exposure keratitis

Station 3:

Name the instrument

Siegle's pneumatic aural speculum
Name it uses
1. Examination of ear drum
2. Testing the mobility of the ear drum
Write down its magnification factor
2.5 times

Station 4:

Examine the right ear of this patient

1. Describe the lesion
Cotton wool like mass seen occluding the external auditory canal. Black spots are also
2. What could be the probable diagnosis ?
3. What could be the causative organisms?
Aspergillus Niger - black spots
Candida - Cotton wool like mass

Station 5:
Perform otoscopy on this patient

Comment on the ear drum

1. Loss of light reflex

2. Prominence of handle of malleus

3. Loss of mobility of ear drum
4. Retracted ear drum

Station 6:
Name the structures numbered

1. Round window
2. Stapedial tendon
3. Pyramid
4. Long process of incus

Station 7:
Write down the possible causes of bilateral retracted ear drum
1. Nasopharyngeal carcinoma
2. Following adenotonsillectomy (Iatrogenic)
3. Cleft palate

Station 8:
Comment on ear discharge of this patient

What could be the possible diagnosis ?

1. Scanty
2. Foul smelling
3. Blood tinged (sometimes)
4. CSOM with attic cholesteatoma

Station 9:
Name this condition seen on the ear drum
Enumerate 3 causes for it

1. Tympanosclerosis
2. Due to resolved otitis media
3. Trauma
4. Grommet insertion (Iatrogenic)

Station 10:

65 years old man

Known diabetic for 15 years on poor glycemic control
c/o pain left ear - 1 month
Blood stained discharge from left ear - 1 month
Tragal tenderness left side - 15 days
Inability to close left eye - 10 days
Otoscopic finding:

1. What could be the possible diagnosis ?

2. Name the probable causative organism
3. Name the choice of antibiotic
Malignant otitis externa
Psuedomonas aeruginosa is the probable causative organism
Carbenicillin / IV generation cephalosporins

Station 11:
Enumerate Levenson's criteria for malignant otitis externa
1. Refractory otitis externa
2. Severe nocturnal otalgia
3. Purulent otorrhoea
4. Granulation tissue in external canal
5. Growth of pseudomonas aeruginosa in specimen cultured from external canal

6. Presence of diabetes mellitus / other immunocompromised states

Station 12:
5 years old child
c/o excruciating pain in right ear - 6 hours
H/O URI - 2 days
Otoscopy showed:

Name the diagnosis

Name the various stages of this disorder
Acute otitis media
Stages of acute otitis media:
1. Stage of hyperemia
2. Stage of exudation
3. Stage of suppuration
4. Stage of resolution

Station 13:
Name the surgery performed in AOM
Indication for surgery in AOM

AOM which does not respond to adequate medical managment within 48 hours

Station 14:
Post surgical otoscopic finding of a patient with AOM

Name the instrument used for this surgical procedure

Name the possible surgical complications of myringotomy
Myringotomy knife
Complications include:
1. Dislocation of incudostapedial joint
2. Injury to corda tympani nerve
3. Persistent perforation

Station 15:
50 years old female patient came with

Pulsatile tinnitus - 3 years right ear

Hard of hearing - right ear 2 years
Otoscopic findings:

Pulsatile reddish mass seen behind the intact ear drum

Name the probable lesion
Name the classic sign shown here
What is the role of siegalization in this patient ?
Glomus jugulare
Rising sun sign (Red mass seen behind the intact ear drum)
On siegalization the reddish mass behind the intact drum blances (Brown's sign)

Station 16:
Name the possible clinical features of glomus jugulare
1. Deafness
2. Tinnitus (pulsatile)
3. Imbalance
4. Otorrhoea

5. Facial palsy
6. Endocrine symptoms
7. Head ache
8. Visual disturbances

Station 17:
Differential diagnosis of this lesion:

This is a red drum

Could be due to:
1. AOM - associated with otalgia
2. High jugular bulb - Normal variant. CT scan shows intact jugular foramen
3. Glomus jugulare - associated with pulsatile tinnitus, conductive deafness, positive
Brown's sign. CT scan shows eorsion of jugular foramen.

Station 18:
40 years old male patient
C/O swelling behind left ear - 7 days

Pain in left ear - 4 days

H/O ear discharge - 8 years

What differential diagnosis you can offer ?

1. Subperiosteal abscess
2. Suppurated retroauricular lymph node

Station 19:
30 years old male patient came with c/o
Pain right ear - 1 week
Blocking sensation right ear - 10 days
Mild discharge from right ear - 1 week
Otoscopy shows:

Enumerate otoscopic findings

Mention the possible diagnosis
Mention in brief the pathophysiology of this disorder
Whitish mass admixed with wax can be seen in the external canal
The external canal appears widened
Probable diagnosis - Keratosis obturans
Kertosis obturans occur due to faulty epithelial migration of external canal skin. This
movement occurs in a reverse direction in these patients (i.e. towards the ear drum)

Station 20:
Perform three finger test on this patient
Greet the patient first
Explain the procedure
Reassure the patient
Three fingers are used to perform this test.
Middle finger is used to apply pressure over the well of the concha - Tenderness in this
area indicates tenderness over the antral area
Index finger is used to apply pressure over mastoid process - Tenderness indicates

Thumb is used to apply pressure over mastoid tip - Tenderness indicates mastoid
emissary vein thrombophlebitis

Station 21:

Name the type of pinna seen here

Name some drugs which when ingested during pregnancy would cause this condition
Warfarin, Folic acid antagonists like methotrexate and aminopterin